Bauer Margaret R, Wiley Joshua F, Weihs Karen L, Stanton Annette L
Department of Psychology, University of California, Los Angeles, California, USA.
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia.
Br J Health Psychol. 2017 Sep;22(3):609-626. doi: 10.1111/bjhp.12252. Epub 2017 Jun 19.
Theories and research regarding cognitive and emotional processing during the experience of profound stressors suggest that the presence of intrusive thoughts and feelings predicts greater use of avoidance and that the use of avoidance paradoxically predicts more intrusions. However, empirical investigations of their purported bidirectional relationship are limited.
This study presents a longitudinal investigation of the reciprocal relationship between intrusions and avoidance coping over a 6-month period in the year following breast cancer diagnosis.
Breast cancer patients (N = 460) completed measures of cancer-related intrusions and avoidance at study entry, 3 months, and 6 months later (i.e., an average of 2, 5, and 8 months after diagnosis, respectively).
Cross-lagged panel analyses revealed that intrusive thoughts, feelings, and images at study entry predicted greater avoidance 3 months later, and avoidance coping at study entry predicted intrusions 3 months later, controlling for the stability of intrusions and avoidance as well as time since diagnosis. Findings were not statistically significant for avoidance predicting intrusions, or vice versa, between the 3-month and the 6-month assessment period, during which they declined.
These findings provide empirical support for the theoretical contention that avoidance and intrusive thoughts and emotions reciprocally influence one another following stressful events. Additionally, in the months shortly after breast cancer diagnosis, intrusions and avoidance are positively related. However, the relationships attenuate over time, which could indicate resolved cognitive and emotional processing of the cancer experience. Statement of contribution What is already known on this subject? Following stressful life events, individuals often experience intrusive thoughts and feelings related to the event and they report avoidance of such reminders. Many studies demonstrate that greater intrusions predict more subsequent use of avoidance coping, and other studies show that greater use of avoidance predicts more intrusions. Their reciprocal relation has not been examined, however. What does this study add? This is the first examination of the concurrent, reciprocal influence of intrusions and avoidance. Findings suggest that accounting for the bidirectional influence of avoidance and intrusions best estimates hypothesized models. Higher intrusions and avoidance predicted each other for the first 3 months after study entry, but the relationship diminished 6 months after study entry, perhaps due to productive mental processing of the stress of breast cancer diagnosis and treatment.
关于在经历重大应激源时认知和情绪加工的理论及研究表明，侵入性思维和感受的存在预示着更多地使用回避策略，而使用回避策略却反常地预示着更多的侵入。然而，对其所谓双向关系的实证研究有限。
本研究对乳腺癌诊断后的一年中6个月内侵入与回避应对之间的相互关系进行了纵向调查。
乳腺癌患者（N = 460）在研究开始时、3个月后和6个月后（即分别在诊断后的平均2个月、5个月和8个月）完成与癌症相关的侵入和回避测量。
交叉滞后组分析显示，研究开始时的侵入性思维、感受和意象预示着3个月后更多的回避，研究开始时的回避应对预示着3个月后的侵入，同时控制了侵入和回避的稳定性以及诊断后的时间。在3个月和6个月评估期之间，回避预示侵入或反之的结果在统计学上不显著，在此期间它们有所下降。
这些发现为以下理论观点提供了实证支持，即回避与侵入性思维和情绪在应激事件后相互影响。此外，在乳腺癌诊断后的几个月内，侵入与回避呈正相关。然而，这种关系会随着时间减弱，这可能表明对癌症经历的认知和情绪加工得到解决。贡献声明关于该主题已知的内容是什么？在经历应激性生活事件后，个体经常会经历与该事件相关的侵入性思维和感受，并且他们报告有回避此类提示的行为。许多研究表明，更多的侵入预示着随后更多地使用回避应对，其他研究表明，更多地使用回避预示着更多的侵入。然而，它们的相互关系尚未得到研究。本研究增加了什么？这是对侵入与回避的同时性、相互影响的首次研究。研究结果表明，考虑回避和侵入的双向影响能最好地估计假设模型。在研究开始后的前3个月，更高的侵入和回避相互预测，但在研究开始6个月后这种关系减弱，这可能是由于对乳腺癌诊断和治疗应激的有效心理加工。
